There are only two surgeons where I live that do lap banding. They were both willing to do my surgery until today when they got the new Medicare review out and find that Medicare is only going to allow $800.00 for the entire procedure. They will be covering it...but at what cost. The doctors said they have to submit it to Medicare and therefore I can't even be self-pay if I want to. I don't know what to do. Anyone have any advice. I really should get the surgery here in the US because of a number of medical problems, but this just oh so sucks.

Why would Medicare think this lap banding is only worth $800.00. I can't see any dr. taking Medicare now with the price they are being paid and I don't really blame the doctors either. It's a fairly expensive operation.

I'm a little confused by your post... are they still both willing to go through with the surgery?

I don't mean to be unsympathetic to the physicians because I truly believe they should be paid well for their time and expertise. That said, this is not your fault - you don't set the fee schedule for Medicare. Are you worried that they'll give you substandard care? Aside from the ethical considerations, they'd be risking a lawsuit and their reputations. And if you really believe they would cut corners on your surgery then you don't want them performing your surgery. But, I highly doubt this is the case.

You deserve the surgery - go for it!

The interesting thing here is : is the $800 what Medicare will pay the physician for his part in the surgery? Because the band itself costs around $2000 or more - hospital cost. I'd be sure, before I agree to anything how much my hospital stay, supplies and separate OR and physician fees are all going to come to and how much of that Medicare will be paying. Just my 2 cents.. Good luck!

I know it's discouraging, there always seem to be more roadblocks on this path than is fair. But don't you dare give up. You deserve this and you need this, it's your health and your life we are really talking about here.

I do not understand why the doctor's won't do the surgery as long as you agree to pay the difference that Medicare doesn't pick up? That doesn't make any sense to me, but then the red tape of government healthcare usually doesn't. I know it's frustrating and I am sympathetic to your feelings of discouragement and disappointment. Perhaps there is another doctor in your state or a neighboring state that will do it? Just a thought.

Sorry you are having to go through this. Keep us posted on what is going on.

I'll keep you in my prayers that things work themselves out quickly for you.

Cindy

Don't give up! It took me 3 years of fighting insurance companies, almost giving up, then finally I was able to self-pay. You'll find a way. I thought I never would.

Wishing you all the luck!

~Pamela.

The doctors won't do the surgery because Medicare doesn't pay them enough. I don't really blame them. $800.00 is not nearly enough, if what they are telling me is true. I offered to go self-pay and they said that is against the law...they have to file an insurance claim if you have insurance. I'm stuck. I'm about ready to say forgitabout it and see about going to Mexico. My problem there is when I come home I'm 8 hours away from a fill when I need one. I'm stuck in the middle of a desert. I could go to Washington or Utah for my fills and both are a very long way.

I could go to Portland for my surgery. There is a good dr. there that does Medicare patients, but I would have to fly up for the seminar (and I've been to one in Boise. It makes no difference), then fly up and see the dr. and then hopefully for surgery and I would have to keep going back for fills.

I agree with the dr's. that $800 is NOT enough for this type of surgery, but it also leaves me without a surgeon in this area because they can refuse a Medicare patient if they want to. I guess I'll have to put lots more thought into what to do. Mexico really scares me with my health problems though.

The doctors won't do the surgery because Medicare doesn't pay them enough. I don't really blame them. $800.00 is not nearly enough, if what they are telling me is true. I offered to go self-pay and they said that is against the law...they have to file an insurance claim if you have insurance. I'm stuck. I'm about ready to say forgitabout it and see about going to Mexico. My problem there is when I come home I'm 8 hours away from a fill when I need one. I'm stuck in the middle of a desert. I could go to Washington or Utah for my fills and both are a very long way.

I could go to Portland for my surgery. There is a good dr. there that does Medicare patients, but I would have to fly up for the seminar (and I've been to one in Boise. It makes no difference), then fly up and see the dr. and then hopefully for surgery and I would have to keep going back for fills.

I agree with the dr's. that $800 is NOT enough for this type of surgery, but it also leaves me without a surgeon in this area because they can refuse a Medicare patient if they want to. I guess I'll have to put lots more thought into what to do. Mexico really scares me with my health problems though.

Why not let them file on Medicare and you pay the outstanding balance (finance, etc). $800 is a a big joke for payment! I understand you apprehension about Mexico, especially if you are in questionable health. If you can afford to do it, through fianancing or otherwise, I would stay in the states.

My plan all along has been to pay for the surgery because I didn't count on Medicare to come through. The doctors can NOT do the surgery without letting Medicare know, therefore, they cannot allow me to self-pay. I'm really stuck in a rut. There is a dr. in Portland that does do Medicare patients and I'm going to think on this for a week or so and decide if that's an option for me. I'm not sure I truly believe this secretary when she tells me the new Medicare funding is going to be $800.00. I would rather think she is talking about Medicaid the Medicare. I have 5-way-bypass surgery and I got to pick my two doctors. After having been a medical transcriptionist for 38 years I knew the two very best drs. in cardiology and chose them. They had no problem in accepting Medicare and trust me cardiologists and neurosurgeons think they sit on the right hand of God. So if they accept Medicare it's hard for me to believe they are paying these guys so little.

These dr's. here in Boise, Idaho charge $20,000 for the procedure. It is half that in Mexico, but that really isn't an option for me. I'm going to call Medicare tomorrow and speak to someone again that knows more. I'm willing to bet Medicare pays about $10,000 and they simply won't accept it. I think that is reasonable if that is the case.

By the way these two dr's. between them (they just learned the proceedure) have only done 100 lap bands, so maybe my options are better with the person who taught it to them in Portland.

Darned if I know what to do.

Hi, me again, just wanted to say that I happened to be on Medicare when I had my banding done back in 2002. I was also on Medicare due to disability, which I am thrilled to say I am no longer on, thanks to my band.

I did have a supplemental insurance along with Medicare which Florida offered at that time for my area. They initially turned me down, but once the doctor pointed out all of my co-morbidities, they finally agreed.

I understand the frustration and aggravation of dealing with Medicare, however, I won't take garbage from anyone and if they are doing you wrong, you have the right to fight back. These two doctors in your area have to do your surgery under Medicare, they signed an agreement stating that they are willing to accept it and the terms of it. No one holds a gun to their heads and many doctors opt not to accept Medicare. They can't have their cake and eat it too. If they have made the agreement and are now refusing you I would let them know you will report them to Medicare if they refuse you. I would call them and tell them and follow it up with a letter clearly stating what you will do. If they still refuse, report them. I know it's a hassle, and you may not like to be this aggressive, but it really is the right thing to do, IMHO. Doctors are not above the law and they are no better than you or I. I respect doctors when they respect me. If these doctors don't like the terms of their Medicare agreements, than they should terminate the agreements and not accept Medicare period.

Sorry, you'll have to forgive my rantings, but I live in Florida have had to fight for everything from recouping hurricane losses to fighting politicians over their unfair treatment of foster families(my former job was licensing foster parents). So I am used to standing up for my rights and the rights of others who are being treated unfairly, no matter who they are.

Cindy

keep trying, maybe the Dr. will accept medicare at the new price. Do not give up.

Cindy

I live in OHIO and am having my surgery done in Mexico. Even if I have to go back there for fills, it will be less expensive than having it done here. I look at the price tag as an advance on all the money I won't be speding on food, alcohol, diet coke, and fat lady clothes. Considering I eat out at least once a day-I should be about even in a year! I am not trying to downplay the costs-I had to borrow against my retirment, but I refuse to put myself off any longer. I would take a second job, do a home equity, beg or borrow from relatives--ANYTHING. I have spent two months researching the foreign doctors and truly believe we are going to see more and more of this. Our American doctors are forced to spend so much on malpractice insurance--I don't blame them, but I'm not playing that game. I also have some risk factors-but nothing losing the weight won't cure. GO FOR IT-make it happen yourself and quit being at the mercy of the health care system!!

Why not let them file on Medicare and you pay the outstanding balance?

That was exactly what I was thinking, there shouldn't be anything illegal about that!!

Don't give up!! Your life is too important to give up!

Actually MD's must accept what Medicare pays and not bill the patient the rest...that is the deal. That being said, the MD's bill insurance a very large sum. My surgeon billed BC/BS over 15,000 dollars. Blue Cross paid them $1700. and because they in in network that is all they got. Talk to the practice and ask what they routinely get paid by other private insurance. Agree to pay the difference. They can bill you for things that Medicare does not pay for, support groups, preop and post op classes and the like to make up that difference. Someone must have a creative brain in that practice.

So if they only have a hundred bands between them, I am suprised that they are not taking Medicare/Medicaid or any old plan that comes thier way. Usually the way the game is played, is that you take whatever you can, then when your numbers are real high and reputation established, you slowly start eliminating plans that you accept starting with the ones that pay the least.

hi there--new here, but there are local docs who will fill mexican band patients--in fact whoever you go to will (my doc did) probably have a list of local fill docs for you should you decide you don't want to go back to MX everytime you need a fill. just my 2 cents---shrina

7/12/05 Dr. Kuri, Tijuana

272/230/125-150

1st fill Dr. McKeen (San Jose) 1.5cc

2nd Fill Dr. McKeen (San Jose) .5cc (total current fill 2.0cc in a 4cc capacity band)

3rd fill scheduled tomorrow

I've already begun this fight. The office manager from the dr's. office called today to tell me they have received my complaint and are considering doing the surgery, but they DON'T think Medicare will pay a cent. The office manager says she talked to the DIRECTOR for Medicare and they are not paying for the surgery. I have also talked directly with Medicare and I know they are paying and paying more than $800.00. It is Medicade that picks up only $800.00 and I don't have Medicade. Medicare will pay $10,000, but the dr. wants $20,000 for this "package deal" he has with the hospital. I told him let me deal with the hospital that I had worked there 38 years and they would give me a good deal on anything I owed them. The dr. doesn't like this idea. He wants me to pay him and I informed the office staff that they have to under the law submit my claim to Medicare before I'm paying them a dime. I truly believe with the help of my personal physician and a detailed letter she sent to Medicare and received an answer on that they WILL pay for this surgery.

The office manager let me know she doesn't like me already...ask me if I care? I'm betting she is a 20 year old blonde bimbo that weighs 110 lbs. She sounds absolutely disgusted discussing weight or weight issues, so I think we are going to have a go round in the future.

I am a person and I expect to be treated as such. I am no different than anyone else in this country and deserve the same treatment. What is it with people and their negative reaction to overweight people? Society on a whole sure looks at us differently for some reason. Personally, I've had enough and I'm taking a stand.

Now...did that impress you guys?

Thanks all. You have been great. Without you I might not have stood up to this woman as it wasn't characteristic of me to fight for anything.